Rinawati Rohsiswatmo

Divisi Perinatologi
Departemen Ilmu Kesehatan Anak
Fakultas Kedokteran Universitas Indonesia
Penyebab Utama Kematian
Neonatal

Sumber: Riskesdas 20111

PENYEBAB KEMATIAN BAYI BARU
LAHIR 0-6 HARI
PENYEBAB KEMATIAN BAYI BARU
LAHIR 7-28 HARI
5 hal perlu diperhatikan
dalam menangani
gangguan napas BBL
Pastikan suhu aksila BBL 36,5 -
37,50C.
Gunakan oksigen dengan
cermat
Pemantauan saturasi oksigen
dengan benar.
Pastikan sirkulasi sekaligus
kadar gula darah baik.
Pastikan BBL dalam kondisi
aman untuk dirujuk ke
ruangan ataupun fasilitas
kesehatan lainnya.
Pulmonary Transition at Birth
Fluid filled Air-filled
Bagaimana Bayi Memperoleh Oksigen
Setelah Lahir?
FASE TRANSISI SISTEM RESPIRASI-SIRKULASI
JANIN NEONATUS
FASE TRANSISI SISTEM RESPIRASI-
SIRKULASI
JANIN NEONATUS
FASE TRANSISI SISTEM RESPIRASI-
SIRKULASI
JANIN NEONATUS
DUCTUS
ARTERIOSUS

FORAME
N OVALE

DUCTUS
VENOSU
S
BANTUAN PERNAPASAN NEONATUS
KONDISI I II

USAHA NAPAS Merintih Apnea/gasping

TAKIPNEA + -

RETRAKSI + -

BANTUAN NAPAS
CPAP VTP
PEEP 7 Dada mengembang
max.8
FiO2 disesuaikan
 Perbedaan T Piece Resusciator
dan Balon Mengembang
T Piece Resusitator Balon Mengembang
Sendiri
CPAP + -

VTP dengan PEEP + Harus dengan Peep

Valve
Sustained Inflation + -
 PEEP VALVE DENGAN ADAPTOR
Memberikan Tekanan
Akhir Positif pada akhir PEEP
pernafasan (PEEP) ketika
memberikan resusitasi

Digunakan untuk
menghubungkan PEEP
valve ke balon resusitasi

Termasuk PEEP valve 5

cmH2O

Tidak dapat dipakai untuk

CPAP
Tanpa PEEP

Dengan PEEP
 T PIECE RESUSCITATOR

Use of Resuscitation Device for Positive Pressure Ventilation . NRP 6 th

Edition 2 Lesson 3.2012
Advantages of T Piece Resuscitator
This study shows that neonates resuscitated with T-
piece device increased their one-minute to five-
minute Apgar score more rapidly than the Self
Inflating Bag (SIB)

T piece resuscitator offers advantages over the SIB in

terms of ability, to provide continuous positive
distending pressure and consistent

J. Archana T-piece Resuscitator versus Self-Inflating Bag for Preterm Resuscitation an Institutional Experience. Children's
Hospital Of Richmond2012
 A randomized, controlled trial of delivery-room
respiratory management in very preterm infant
te Pas et al
Pediatrics 2007;120:322-9

RCT of 207 very preterm infants using sustained inflation (20

cm H2O for 10 seconds) + NCPAP vs self-inflating bag and mask
+ NCPAP

CONCLUSION:
Sustained inflation through nasopharyngeal tube followed by
NCPAP is more efficient strategy than repeated manual
inflations with a self-inflating bag and mask followed by NCPAP
intubation, IMV, days on CPAP
less RDS, air leak, moderate-severe BPD
 T Piece Resuscitator

(a)
(b)
 T-PIECE RESUSCITATOR
Keterangan Gambar:
1.Manometer untuk
1
mengatur tekanan yang
diberikan
2.Pengatur tekanan PIP 8
3. Outlet port
4.Sirkuit Pasien 2
5.Sungkup
6.Inlet port (Oxygen 6
port)
7.Selang Oksigen 3
8.Katup pengaman
9.Lubang sungkup 7
10. Lubang PIP 4
5

10 9
Mixsafe Transport
 CPAP di Ruang Rawat

Standart Bubble CPAP

Ventilator Untuk
Neonatus dan Pediatrik
 1

5 4

KeteranganGambar :
1. Tiang 66
2.Heater
3. Reuseable tube set
4. Oksigen udara blender 8
5. Botol humidifier
6. Control panel
7. Tempat tabung oksigen 7
8. Perangkap air
9. Kompresor udara mini
(inside) 9 10
10. Preasure gauge
compressor
Bubble Generator Humidifier
Humudifier Display Layar
Sensor Suhu Mini Compressor
Sensor Suhu

Preasure gauge
compressor
 High Flow Nasal Cannula
Humidified high-flow nasal cannula (HHFNC) therapy:
Optimally warmed and humidified respiratory gases
delivered by nasal cannula at flow rates between 2 and 8
L/min
 CARA MEMBERIKAN OKSIGEN
Sumber gas :
Oksigen harus dicampur dgn udara. Pemberian oksigen
HB > dari 4 liter setara dengan 100% O2
1 liter oksigen 9 liter udara = 30 %
2 liter oksigen 8 liter udara = 40 %
4 liter oksigen 6 liter udara = 50 %
5 liter oksigen 5 liter udara = 60 %
6 liter oksigen 4 liter udara = 70 %
7 liter oksigen 2 liter udara = 80 %
9 liter oksigen 1 liter udara = 90 %
10 liter oksigen 0 liter udara = 100 %
RWH Procedure Manual 2005
 Tabel Konsentrasi Oksigen
untuk Campuran Udara dan Oksigen
Udara Bertekanan (liter/menit)
%
kons. O2
1 2 3 4 5 6 7 8 9 10

1 41% 37% 34% 32% 31% 30% 29% 28%

2 61% 53% 47% 44% 41% 38% 37% 35% 34%

Oksigen (liter/menit

3 80% 68% 61% 55% 51% 47% 45% 43% 41% 39%

4 84% 74% 66% 61% 56% 52% 50% 47% 45% 44%

5 86% 77% 70% 65% 61% 57% 54% 51% 49% 47%

6 88% 80% 74% 68% 64% 61% 57% 54% 53% 51%

7 90% 82% 76% 71% 67% 64% 61% 58% 56% 54%

8 91% 84% 78% 74% 70% 66% 63% 61% 58% 56%

9 92% 86% 80% 76% 72% 68% 65% 63% 61% 58%

10 93% 87% 82% 77% 74% 70% 67% 65% 63% 61%
Cara Memberikan Oksigen
STOP ROP FiO2 conversion table
Conversion Table
BACK
 SIMPULAN
Pada bayi dengan sindrom gawat napas
direkomendasikan untuk memberikan CPAP dini
sejak di kamar bersalin untuk menurunkan
morbiditas, kebutuhan bantuan ventilasi
Pemberian CPAP saat bayi baru lahir sebaiknya
menggunakan T-Piece Resusciator
Oksigen harus dicampur dengan medical air
Berbagai Cara Pemberian CPAP di
Kamar Bersalin
1. Nasal kanul
Aliran udara tinggi diberikan melalui hidung
PEEP kecil, FiO2 tinggi
2. Head Box
3. Jackson Rees
4. T-piece Resuscitator
Head box 5 L/menit
PEEP 3

O2 Nasal PEEP lebih

kecil

Kurang
dianjurkan
 Cara Memberikan Oksigen
Head box 02
Kec. Aliran 5 7 L /menit
Kec. Aliran > 7 L/menit: O2 , berisik,
bayi muntah
Perlu kec. aliran tinggi untuk mencapai
kons. O2 yg adekuat dan mencegah
penumpukan CO2
Aliran gas 2-3L/menit diperlukan untuk
mencegah rebreathing CO2
 JACKSON REES
digunakan untuk
pemberian CPAP pada
neonatus dan bayi
menggunakan sumber
oksigen atau campuran
oksigen dan udara tekan
dapat dihubungkan
dengan sungkup
berbagai ukuran
Jackson Rees with lid or nasal
prong
HHFNC Delivery Systems
Fisher Paykel Healthcare Optiflow Junior
Nasal Cannula
Limited in maximal flow rates delivered using
Fisher Paykel nasal cannula
8 L/min
Narrow circuit calibre generates high resistance
and high pressures within circuit proximal to
nasal cannula.
Pressure relief valve limits pressures within
circuit to 40 cm H2O.
Limited value in increasing flow above 8
L/min.
 CPAP Pressures with HHFNC

Wilkinson et al measured pharyngeal pressures in infants 1

4 kg on HHFNC using flow rates of 2 8 L/min.
(J Perinatol 2007)
HHFNC Delivery Systems
Vapotherm Precision Flow Device
Uses patented membrane technology to deliver
molecular vapor with 95% to 100% relative
humidity at body temperature through nasal
cannula at flow rates between 8 (infants) and 40
L/min (adults).
Respiratory circuit consisting of a sleeve of
recirculated warmed water encasing the delivery
tube enables delivery of warmed humidified gases
to distal end of the circuit.
Uses nasal prongs similar to those used for
High Flow.
alamat website pembelian alat CPAP
made in indonesia :

www.pendar-ap.com